title: Pragmatic diabetes management in nursing homes: individual care plan.
abstract: Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients. Given demands on NH personnel (manager, medical coordinator, nurses, and, at the front line of care provision, the undertrained and overworked carers), coupled with the quasiconstant of high staff turnover, the foundation stone of a patient's diabetes management is an Individual Care Plan (ICP) expressed in layman's language. This document that is opened on the patient's admission aims to make sure that the prescriptions established at admission are followed, notably to ensure correct treatment and adapted, regular monitoring with dates and times when examinations and tests are due. This includes monitoring of the diabetes control (HbA1c and, if necessary, blood and urine glucose) and its complications (cardiovascular disease, hypoglycemia, ocular problems, foot disorders, malnutrition, peripheral neuropathy, kidney failure). A necessary corollary is the training of staff to understand the specificities of caring for a frail patient with diabetes, on what to do in a potential emergency, and how to keep the ICP up to date for consultation by doctors and nurses.
authors.affiliation: Département de Gériatrie, CHU de Nancy, Vandœuvre-lès-Nancy, France; Université de Lorraine, France. Electronic address: a.benetos@chu-nancy.fr.
authors.forename: Athanase
authors.initials: A
authors.lastname: Benetos
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Novella
authors.forename: Bruno
authors.initials: B
authors.lastname: Guerci
authors.forename: Jean-Frederic
authors.initials: JF
authors.lastname: Blickle
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Boivin
authors.forename: Pierre
authors.initials: P
authors.lastname: Cuny
authors.forename: Brigitte
authors.initials: B
authors.lastname: Delemer
authors.forename: Thierry
authors.initials: T
authors.lastname: Gabreau
authors.forename: Philippe
authors.initials: P
authors.lastname: Jan
authors.forename: Jacques
authors.initials: J
authors.lastname: Louis
authors.forename: Yves
authors.initials: Y
authors.lastname: Passadori
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Petit
authors.forename: Georges
authors.initials: G
authors.lastname: Weryha
mesh_terms: D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D016330:Frail Elderly; D005853:Geriatrics / Q000193:education; D006801:Humans; D007318:Inservice Training; D009735:Nursing Homes; D010347:Patient Care Planning; D019338:Polypharmacy; D012307:Risk Factors
keywords: Diabetes; frailty; hypoglycemia; nursing home